Healthcare Provider Details

I. General information

NPI: 1255404638
Provider Name (Legal Business Name): LESLIE B. WHITE, INC,, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S 152ND ST
BURIEN WA
98148-1107
US

IV. Provider business mailing address

445 S 152ND ST
BURIEN WA
98148-1107
US

V. Phone/Fax

Practice location:
  • Phone: 206-246-5370
  • Fax: 206-246-4806
Mailing address:
  • Phone: 206-246-5370
  • Fax: 206-246-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH00000759
License Number StateWA

VIII. Authorized Official

Name: DR. LESLIE BOYD WHITE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 206-246-5370